In addition to the many and varied medical problems which hospitals are called upon to treat, they also face a serious procedural or administrative problem which affects the medical treatment of patients, namely, the correlation of patients to specimens, records and thus diagnosis and treatment. Perhaps this problem is nowhere more acutely felt than in connection with blood transfusions. As is stated in TRANSFUSION, the Official Journal of the American Association of Blood Banks,
"Once the decision to transfuse --rightly or wrongly, has been made, there is a very serious risk of identification errors. Indeed, human mistakes, particularly in identifying blood samples and patients, continue to cause the largest proportion of transfusion fatalities." (July-August, 1977, at page 305)
The problem of assuring correlation between a patient, his blood specimen and the blood unit from the blood bank is particularly troublesome in hospitals in urban areas which act as major trauma centers and may be called upon to treat several acutely hemorrhaging patients at the same time. The need for blood components on a STAT basis is common, and may be complicated by the fact that the patient's identify is often unknown. Clerical errors in the handling of specimens under the pressure of emergency service understandably can occur, and they are extremely dangerous since the patient is often taken directly from the emergency room to the operating room in an anesthetized condition, making the infusion of mis-matched blood more likely to be lethal.
While the problem is perhaps most dramatically illustrated in connection with correlating the blood specimens taken from a patient with the blood components to be infused into the patient, the same potential problem arises in connection with correlating other types of specimens and pharmacological agents, as well as patient records and treatment. Clerical error can result in the dispensing of the right medicine or treatment to the wrong patient, with disastrous consequences.
Some attempts have been made in connection with blood transfusions to help the physicians, phlebotomists, and technologists assure the correlation of blood specimens, units of blood and the patient by use of a separate and additional identifying means. One such prior system is known as the TYPENEX System, which is a kit marketed by Fenwal Laboratories of Deerfield, Illinois. The TYPENEX System includes a package of ten wristbands and ten strips of pre-numbered labels each having identical indicia or numbers thereon. The wristbands further have a label on which the patient's name can be entered removably positioned thereon. The system is used by writing the name, hospital identification number and the date on the label on the wristband, usually by copying from the hospital wristband. This label is then removed and pressed onto a blood specimen tube, carrying with it a patient identifying indicia. The information recorded on this label is also automatically transferred through to a portion of the wristband under the removable label. Additionally, a strip of labels having the identifying indicia on the wristband is also attached to the specimen tube so that they will travel with the tube to the blood bank area. The labels in the strip can then be detached and placed upon the units of blood that are matched to the patient specimen.
While advantageous in many respects over the prior systems, the TYPENEX System inherently has certain disadvantages. First, while the carbon imprint of the patient's number remains on the wristband, the labels can be peeled off by the patients, either deliberately or unconsciously and can become affixed to something else. Secondly, when there are multiple patients, multiple wristbands, multiple strips of labels and multiple specimen tubes, making wristband entries, placing the proper labels on the proper sample tubes, and generally locating the parts for and "building" the specimen tube-patient correlation system under the pandemonium of emergency trauma center conditions is not highly reliable. The writing, peeling off and sticking on of labels will be the first procedures eliminated in emergency conditions by physicians trying to get to the treatment of patients. Still further, the strip of labels which are removably attached to the blood specimen tubes can interfere with such blood bank activities as centrifuging. Some would have to be removed and a further responsibility placed on the technologist to properly use and/or destroy them.
A similar system is marketed under the trademark IDENT-A-BLOOD by Hollister Incorporated of Chicago, Illinois. The IDENT-A-BLOOD system includes a wristband and a sheet of pressure sensitive labels. The sheet of labels includes a wristband label, a specimen tube label, a plurality of chart, blood bank charge and identification labels, chart and log book labels, and patient, physician and hospital identification labels. Again, the system is based upon the physician's or other phlebotomist's ability to "build" the system under emergency conditions. The wristband label has to be filled in, peeled off the master label sheet and inserted into the wristband, all before mounting the wristband on the patient. The insertion process alone can be tedious or impossible if the wristband tube is not completely open, which does occur. The sample label has to be peeled off the master sheet and placed on the specimen tube, and the master sheet has to be forwarded to the blood bank with the specimen so that still another label can be peeled off and placed on the unit of blood to be returned to the patient. Additionally, chart labels and the like have to be peeled off and placed on appropriate records for the patient.
The prior multiple label patient-specimen correlation assurance systems, therefore, can be seen to have two inherent disadvantages. First, the necessity of building up the system under emergency conditions may produce an error in labeling or the like; and secondly, the complexity and time required to build up the correlation apparatus may cause physicians, phlebotomists and technicians to simply relegate use of the system to those situations in which time is not critical.